J Korean Soc Radiol.  2015 Sep;73(3):190-194. 10.3348/jksr.2015.73.3.190.

Retained Bone Wax on CT at One Year after Dacryocystorhinostomy: A Case Report

• Kim SH
• Park D
• Lee J
• Lee Y
• Jeong J

• KMID: 2043611
• DOI: http://doi.org/10.3348/jksr.2015.73.3.190

Abstract

A 71-year-old man with chronic rhinosinusitis presented with a purulent, foul-smelling nasal discharge and obstruction. One year earlier he had been treated with a dacryocystorhinostomy for nasolacrimal duct obstruction. During the procedure, bone wax had been used to control bleeding in the anterior upper nasal cavity. On computed tomographic imaging, a fat-density lesion was seen in the anterior upper sinonasal cavity and was found to be hypointense or signal-void on all magnetic resonance imaging sequences. The lesion, which proved to consist of bone wax, was surgically removed. Here, we present the imaging features of retained bone wax in a patient with clinically diagnosed chronic rhinosinusitis after dacryocystorhinostomy.

MeSH Terms

Aged
Dacryocystorhinostomy*
Hemorrhage
Humans
Magnetic Resonance Imaging
Nasal Cavity
Nasolacrimal Duct
Tomography Scanners, X-Ray Computed

Figure

• 

  Fig. 1 Endoscopic view showing a whitish, glittering foreign body filling the anterior upper nasal cavity, medial to the upper attached part of the right middle turbinate.

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  Fig. 2 CT images obtained in a 71-year-old man with chronic sinusitis that developed one year after dacryocystorhinostomy. A. A pre-enhanced axial CT scan of the paranasal sinus shows a fat-density lesion (about -70 HU) filling the right anterior upper nasal cavity (arrow). B, C. Post-enhanced and coronal reformatted CT images in a bone window setting show a fat-density lesion (arrow) around the upper attached part of the middle turbinate and a right lacrimal bone defect adjacent to the lacrimal sac. The nasolacrimal duct remained patent (arrowhead) but was slightly compressed by the lesion. D. On axial CT scanning, a lump of bone wax (arrow) floating in a cup of water shows the low attenuation of fat (about -100 HU), as compared with the intermediate attenuation of water (about 0 HU). HU = Hounsfield units

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  Fig. 3 After gadolinium injection, MRI scans were obtained showing a hypointense or signal-void lesion (arrow) on all sequences, including T1-weighted (A), T2-weighted (B), and axial and coronal contrast-enhanced T1-weighted (C) images. Signal-void coronal T1-weighted (D) and T2-weighted (E) MRI scans of a cube of bone wax floating in a cup of water.

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  Fig. 4 Endoscopic sinus surgery was performed, and pieces of bone wax of various shapes and sizes (to a maximum of about 1.5 × 1.5 cm) were found and recovered.

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